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Making the Undergraduate-to-Medical-School Transition

During medical school orientations just a few decades ago, it was common for the Dean or another senior speaker to say to the assembled freshman class: “Look to the right of you…look to the left of you… [and in solemn tones]…in four years one of you three will not be here.” Happily for today’s medical students, dire threats and gloomy predictions have long since become unacceptable, and medical schools strive for their students’ success. However, in many ways the transition from undergraduate to medical student is more challenging today than ever. Medical schools have a complex selection process that carefully vets applicants and admits only students it judges to have the intellect and ability to succeed. Still, in each class some medical students struggle, particularly in the first 2 years. Why do some students do poorly or even fail and what should new or prospective medical students do to raise their odds of success?

A major reason medical school is challenging is that students are exposed to a new way of learning, which differs from the methods of most undergraduate programs in two ways:

  1. Case-based learning largely replaces the conventional didactic lectures.
  2. Learning is centered on groups of medical students working as teams.  

This is a radical departure from the “Lone Ranger” method of individual learning that undergraduates are used to. In the team system, medical students work together to tackle problem sets. They teach and learn from each other with faculty input and supervision. The team approach, combined with case-based learning, has proven pedagogically superior; working in teams stimulates learning and increases retention (see references 1 and 2 below). Another advantage is that while individual accountability and responsibility remain essential, medical care increasingly depends upon teams of caregivers; if you don’t learn to work in teams in medical school, where will you learn this skill?
Another reason students struggle is that in medical school the pace of learning is much faster than what they’re used to. There’s more material to master in less time. Medical knowledge increases very quickly, so each new class has more to learn. The knowledge needed to be a physician is voluminous and complex, often requiring intensive concentration and study to be fully understood.  Effective teamwork and case-based learning facilitates the learning process–but also calls for flexibility, adaptability, and maturity beyond what is needed to excel as an undergraduate. Sub-par performance results in remedial work; weak students may even need to repeat the school year.
So how does one assure success in making this transition? There is no single answer, no magic rule. However, here are 10 suggestions that address the major obstacles to success:

  1. Make the necessary emotional and psychological adjustment to deal with 4 extremely tough academic years. Yes, this is within your control. Get used to having less time for family and friends, recreation and social life.
  2. The summer before you start medical school, obtain a reading list and possibly a textbook or two. Get a head start on your work and adjust your frame of mind towards serious study.
  3. Once medical school has started, take an engaged and active role in your teams and study group. When working in a group, there’s a tendency to focus on your own contributions more than those of your teammates. Avoid it; you need to know all the material, so focus on the contributions of others at least as much as you focus on your own. 
  4. Limit distractions. There is no end of attractive opportunities for committees on class affairs, participation in clinics for indigent patients, community teaching, and other laudable efforts–but school work comes first.
  5. Think realistically about ways of incorporating research into your medical school experience. If you affiliate with a laboratory, make a commitment that does not encroach too much on your medical class work. If you have a passion for research, consider taking a year off to work in a lab. In addition, many schools with M.D.-Ph.D. programs will consider allowing interested and qualified students to transfer to the program through their second year. This is an attractive opportunity for some.
  6. Although exam scores and grades are usually not entered on your official transcript until the 2nd or even 3rd years, pay close attention to how you are doing on quizzes and exams and respond when there are indications that you may need to study more or get help.
  7.  Familiarize yourself with and take advantage of mentoring and other academic support services. These are extensive, accessible, and well-organized at most institutions. Periodically review your progress and review any concerns with your assigned mentor.
  8. Medical Schools are not monasteries or cloisters. Close friendships and relationships develop and can be rewarding–but maintain stability in your personal life.
  9. Don’t spend time and mental energy worrying about future decisions such as what specialty to select or where you will do your postgraduate training. The curriculum is designed to give you the experience and information you need to make a carefully considered decision regarding specialty choice, residency, and fellowship–at the appropriate time.
  10. Eat well, sleep sufficiently, and exercise regularly. The ancient Greek philosopher was right–a sound mind in a sound body is what it takes.

It cannot be stressed enough that the first two years of medical school provide the foundation for the knowledge you need in your medical career.  Not only your success as a medical student, but the health and well-being of your future patients depend on the preparedness, commitment, and hard work you bring to bear those first two years. Make them count!
1.    Michaelsen L, and B Richards. 2005. “Drawing conclusions from the team-learning literature in health-sciences education: a commentary”. Teaching and Learning in Medicine. 17 (1): 85-8.
2.    Williams, B. 2005. Case based learning–a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J. 22:577-581 doi:10.1136/emj.2004.022707.